If you’re having serious back pain week after week (or day after day), you might worry that surgery is in your future. This may even make you nervous about telling your doctor about your persistent back pain, keeping you from getting any relief or guidance at all.
But the truth is, you’ve got a variety of methods to treat back pain, and many of them are effective at reducing pain and improving patients’ quality of lives, long before surgery is even considered.
“When it comes to treating back pain, we have a lot of different options,” says Kaliq Chang, MD, pain specialist in New Jersey. “The goal is to reduce the inflammation that’s causing the pain.”
Here are the different options doctors recommend, from least to most invasive.
1. Lifestyle changes.
The first thing doctors will recommend for back pain is simple lifestyle changes. Certain lifestyle choices can lower the amount of inflammation in the body, so eating an anti-inflammatory diet, finding and maintaining a healthy weight, exercising regularly, and quitting smoking may be helpful. Learn more about lifestyle changes to treat back pain at home.
2. OTC medication
You might be able to successfully relieve episodes of acute back pain using simple OTC medications like ibuprofen. Ibuprofen blocks the body’s production of a substance in the body that causes pain, swelling, and inflammation.
3. Physical therapy
“Physical therapy is recommended for all patients that are experiencing back pain,” says Dr. Chang. “When the pain is too severe … for undergoing therapy, [that’s] when you should see a pain management doctor.”
4. Muscle relaxers
“If you’re experiencing a lot of muscle spasms and muscle tenderness accompanying your back pain, it may be useful to try a prescription muscle-relaxing medication,” says Dr. Chang.
Muscle relaxers are an anti-inflammatory medication that works well for short-term pain relief. These are typically not prescribed for chronic pain management.
5. Nerve pain medication
Most pain relievers address the muscles and joints, but these medications actually blunt the pain signals at the nerve level. The nerves are usually just the “messenger” of pain, so dampening the signal results in reduced pain sensations.
6. Opioid medications
Opioid medications are only used as a last resort to relieve pain, according to Dr. Chang. This is, of course, to the addictive nature of these medications.
When opioid medications are used to treat back pain, they are specifically a short-term solution. “They’re only effective in the acute pain setting,” says Dr. Chang. “Within a matter of weeks, the patient’s body develops a tolerance to these medications, and they’re no longer effective.”
7. Nerve blocks
Also called nerve ablations, this unique treatment blocks or burns sensory nerves in the pain area by injecting an anesthetic solution to relieve chronic pain.
8. Epidural steroid injections
First of all, these are *not* the same as the epidural anesthetics used to relieve pain during childbirth. Instead, these steroid injections are a short-term treatment option that helps inhibit inflammation to reduce pain.
“Epidural steroid injections are a procedure that takes only a few minutes, and is done very safely with the guidance of continuous X-rays throughout the procedure,” says Dr. Chang.
9. Regenerative medicines
A newer type of treatment for back pain is regenerative medicine. As the name suggests, it attempts to regenerate damaged tissue in the discs. Types of regenerative medicine include stem cell injections and platelet-rich plasma injections.
10. Spinal cord stimulators
A spinal cord stimulator is “a device that modulates the patient’s perception of the pain,” says Dr. Chang. The small device is surgically inserted at the neck and sends low-voltage electric pulses to the nerves of the spinal cord to block the pain sensation, according to the American Association of Neurological Surgeons.
Finally, doctors may recommend surgery if other options have not resulted in relief. Surgery is considered only if there is a single known cause for the pain that can be fixed or removed. Most commonly, surgery is used for herniated discs, spinal stenosis (the narrowing of the spine), or spondylolisthesis (when a fracture weakens the spine and causes the vertebrae to slip out of place).
Here are examples of surgeries to treat back pain, according to the Arthritis Foundation:
Discectomy, which removes part of the herniated disc.
Laminectomy, which removes the lamia (the back of the spinal canal) and enlarges the spinal column.
Spinal fusion, which fuses two or more vertebrae together to form a immobile spine in order to stop the progression of deformities or injuries.
Vertebroplasty and kyphoplasty, which fixes fractured bone in the vertebrae using a cement-like material.
“When you start to experience back pain, it’s appropriate to see your primary care physician, who can guide you in the initial treatments, including medications and conservative therapy,” says Dr. Chang. “However, when the pain issue persists beyond those points, you should seek a pain management consultation.”